Saw GP today. I think I must've been his last patient as there were a lot of rolling of eyes and huffs. He doesn't have the best bedside manner at the best of times.

I asked if I could have my injections every two months but he argued that the last blood test showed my B12 was more than 1500 so symptoms (burning feet and legs, sheer fatigue etc, etc) couldn't possibly be down to B12. I tried, in my befuddled way, to quote NICE and BNF guidelines and he finally agreed to injections every two months but said he would refer me to an endocrinologist.

Not sure what he is looking for and didn't dare ask why. Is there anyone who could throw any light on his reasons and advise my best way forward?

Thank you so much for those of you on here who are so knowledgeable. What would we do without you.

17 Replies

The only reason I can think of for why he is referring you to an endocrinologist is that he can't spell haematologist. The NICE guidelines quite clearly say that the should refer you to a haematologist.

Please don't give up: it's nothing to do with how many wonderful years of experience you have - we're all struggling with insensitive, illogical medics!!

I think that a major reason why people feel "old" is because declining absorption as their years increase means that they start to show B12d symptoms. I wonder what would happen with blanket supplementation across the whole population?!?

I like your take on growing older and yes, I do have many wonderful years of experience! Can't see 'them' ever doing anything like blanket supplementation when they seem so stuck in denial but a great idea. I strongly suspect, with the benefit of hindsight and what I know now, my mum died from undiagnosed PA at the age of 59.

An endocrinologist is a specialist in hormone conditions, so it will be to look at the possibility of things such as Thyroid condition, Adrenal Gland problems etc. Though I'm surprised that they just referred you, usually there would be something show in your blood tests to get a referral ?

This isn't actually a bad thing as I've read a lot on another board about links with PA & other autoimmune conditions such as those above, so getting them ruled out (or diagnosed & treat) is a very good idea. If the Endo finds nothing, then hopefully they will support you needing more injections - if nothing else,Mir gives you a stronger argument with your GP

Thank you rockinHippy. What you say makes sense. Dr didn't mention any reason for referral other than he really wasn't happy to increase frequency of B12. Maybe there is something else he's not telling me. Either way, will be good to rule anything else out.

Sadly your GP is of the ill-informed type of guy - unprepared to learn new things. Once you are being treated for B12 Deficiency subsequent tests tell you very little. You need B12 in the cells so the blood test is just a guideline to help with diagnosis and only 20% of the result can reach the cells where it is needed.

He's likely to have referred you to an endocrinologist to see whether you have a metabolic disorder that means you use up b12 too quickly (hence becoming symptomatic early). A haematologist friend recently suggested to me that I ask my GP to refer me to an endocrinologist, after she informally asked colleagues from other departments why I might be symptomatic a month after getting my jab. An endocrinologist colleague suggested I might have a metabolic disorder that meant I use up b12 far too quickly. Apparently he has patients that he b12 injects every 1-3 weeks as a result.

I would have some thyroid tests done first - the TSH - FT4 - FT3 and Thyroid anti-bodies Anti-TPO and Anti-Tg. The last two are anti-bodies that attack the thyroid - and auto-immune condition affecting the thyroid. Both my husband and I have it. He was diagnosed quite late in life at 72. Auto-immune issues often come together.

Endocrinologists often specialise in diabetes and have little knowledge about how the thyroid really works. This is my opinion after being on the Thyroid UK forum here on HU for 4 years.

The Thyroid is the master-gland of metabolism and thyroid hormones are needed in every cell of the body - trillions and trillions. So if you are low of T3 then there will not be enough to go around all those cells